Myth vs. Fact: Sorting out mental illness, violence relationship

The goal of this series of articles is to diminish the stigma of mental illness through sorting out fact from myth.

Hollywood films, — such as Alfred Hitchcock's "Psycho," Jim Carpenter's "Halloween" series and Christopher Nolan's "The Dark Knight" — headline stories in the news of violent acts perpetrated by a few with major mental illness, and inflammatory statements by politicians provide a dangerous distortion of the facts.

An example of political misinformation comes from The Washington Post on Jan. 1, 2016, where Juliet Eilperin quotes House Speaker Paul D. Ryan's email, in regards to preventing violent acts such as those at Sandy Hook Elementary School in Connecticut, "... Our focus should be on the consistent causes of these acts — mental illness and terrorism..."

Films, news articles and political posturing that villainize persons with mental illness deepen the stigma, adding to the suffering already experienced by those with a brain disorder. A person with schizophrenia no more asked for his/her symptoms than did someone with diabetes or glaucoma.

Stigma and violence foster each other. It isn't unusual for those who are stigmatized to experience hurt, frustration and anger. People on the fringe, due to any factor that marginalizes them, have less stake in maintaining the current order of the society in which they live. Is it possible that a percentage of the violence attributed to mental illness may be more accurately accounted for by marginalization?

Even so, those with mental illness are not by-and-large violent people. Contemporary research shows that: 1.) The majority of violent crimes are not committed by those with major mental illness; 2.) Persons with major mental illness are more likely than the general population to be victims of violent crimes; and 3.) Of the approximately 5 to 10 percent of violent crimes committed by people with major mental illness, the majority of those crimes are committed by people with poor insight, who are abusing substances and are not in treatment.

It is true that a higher percentage of those with serious mental illness are likely to engage in violent behavior than those in the general population. This fact speaks more to the reality that we have unsatisfactory resources to treat persons with mental illness, our current tools don't adequately address those who refuse treatment due to lacking awareness of their own condition, and funds are disproportionately allocated to build prisons when we need hospitals. Tending to these details will weaken any association between mental illness and violence.

Taking away guns from those who have mental illness would do little to decrease gun violence in the U.S. According to Louis Beckett's interview with Dr. Jeffrey Swanson in ProPublica, June 10, 2014, if one was to remove, "all the risk associated with mental illness ... contributing to people killed by gunshot wounds in the last 10 years ... 95 percent of the reduction would be from suicide. Only 5 percent would be from homicide." He goes on to say, "Mental illness is a strong risk factor for suicide. It's not a strong risk factor for homicide."

Thus, suicide, often associated with depression, is the main reason persons with mental illness should not have guns. And since we are all at risk for depression, and many suicides occur in persons with undiagnosed depression, perhaps gun ownership should be severely limited for this reason alone.

The focus on guns and mental illness misses the point when the combination is thought to be a large reason for the violence in our communities. This being said, a focus on research and effective treatment would help to lower the risk of gun violence and suicide in those suffering from mental illness. A well-treated person with mental illness with a gun is at much lower risk of committing violence than is an untreated person without a gun. This is not to argue in favor of guns, but simply to point out that being a mentally ill citizen is one matter and whether or not anyone is at risk of gun violence is another.

As long as we use persons with mental illness as responsible for begetting the ills of society, so do we again avoid solving the problems that face us.

Carolyn Sacco, RN has worked as a nurse in psychiatry since 1985, with people in hospital, clinic and home settings. Jeffrey Geller, MD. MPH is professor of psychiatry at the University of Massachusetts Medical School. He also works treating people in the community and hospital.

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